Evidence Classification and Reflection (ECR) Form
NOTE: This form must be included with each piece of evidence. If the evidence will be used for more than one
Accomplished Practice plus a Standard and/or Outcome, a separate ECR must be completed for each of the
appropriate Accomplished Practices, Standards, and Outcomes. Each artifact may be used a maximum of two
times for the Accomplished Practices, one time for standards, and referenced for one Program Goal.
Student Name: _______________________________________
Student ID #: _______________________
Date Evidence Created: ________________________________
Associated Course: __________________
Accomplished Practice
Check One:
Standard for CCC
Check One:
____ 1. Assessment
____ 2. Intervention Skills
____ 3. Communication
____ 4. Continuous Improvement
____ 5. Diversity
____ 6. Ethics
____ 7. Human Dev. and Learning
____ 8. Knowledge of Course Content
____ 9. Technology
____ 10. Planning
____ III-B
____ III-C
____ III-D
____ III-E
____ III-F
____ III-G
____ III-H
____ IV-B
____ IV-C
____ IV-G (1)
____ IV-G (2)
____ IV-G (3)
Program Goal
Check One:
____ PG #1
____ PG #2
____ PG #3
____ PG #4
____ PG #5
____ PG #6
____ PG #7
____ PG #8
____ PG #9
Clinical Category
Check One:
____Articulation
____Fluency
____Voice
____Rec/Exp. Comm.
____Social Comm.
____Cognitive Comm.
____Comm. Modalities
____Swallowing
____Hearing
Title of Evidence: ________________________________________________________________________
Type of Evidence (Circle or Underline One): Performance, Product, Tests and Records, Clinical Outcomes,
Testimonials, Professional Values and Commitments
1. Brief Description (In one or two sentences, describe the artifact in clear and simple terms):
2. Description of Context for Which Evidence Was Created:
(ECR form continued on next page)
Oct 2005
3. Accomplished Practice, Standard, and/or Outcome Demonstrated: Precisely explain how the artifact is used
as evidence for the Accomplished Practice/Standard/Outcome identified under “Types of Evidence” noted
above. In this section, you must convince the evaluator that the artifact chosen is appropriate evidence for
the identified Accomplished Practice, Standard, and/or Program Goal.
4. Growth and Knowledge of Professional Competence: Explain the increase in knowledge and professional
competence you experienced through this particular piece of evidence as an Accomplished Practice,
Standard, and/or Program Goal.
5. Areas of Improvement: Discuss ways in which you would improve upon this evidence if given the
opportunity to develop and use it again. How would you change what you did? (Note: “Continuous
Improvement” implies that there is always room to make something better. Even if you were satisfied with
the results and the evidence, there are ways to improve.)
Evaluator’s Signature: _______________________________________________ Date: __________________
Evaluator’s Position/Title: ____________________________________________________________________
Oct 2005